Medicare disappointment

Congrats on joining the joining the discussion at TuD, @spjwt. Medicare recipients must do several things to get their insulin covered at 100% following payment of the annual deductible:

  • Subscribe to traditional Medicare, not Medicare Advantage.

  • Buy a Medicare Supplement plan. These plans are designated by letters like F and G. AARP sells all kinds of insurance plans, not all of them are the lettered Medicare Supplement plans. You are not eligible to purchase a lettered Supplement plan unless you have already subscribed to a traditional Medicare plan.

  • Use an insulin pump.

  • Make sure the pharmacy submits the Medicare claim under Part B, not Part D. Pharmacies are not all familiar and experienced with Part B; they’re more experienced with Part D claims. Sometimes you will say “Part B” and they will hear “Part D.” I often say, “Part B as in bravo, not Part D as in delta.” Part B is also known as DME or durable medical equipment coverage whereas Part D is a pharmacy drug benefit.

Once Medicare pays their 80% of their negotiated share, the claim is automatically submitted to the Supplement plan leading to eliminating your out of pocket cost.

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